KARACHI: Health experts have raised alarm over the increasing number of ‘extensively-drug resistant’ (XDR) typhoid cases being reported in the city and have urged the public to adopt good hygiene practices, drink boiled water and avoid eating raw food.

They also called upon the government to initiate efforts for better sanitation and free vaccination campaigns against typhoid, a preventable disease.

XDR typhoid, they said, not only carried high risk of complications and was difficult to treat but was also showing a high relapse rate in children.

“It (XDR typhoid) has become quite common now. We are getting around 30 cases of this disease every week and these stats represent only one hospital,” said Dr Jamal Raza, head of the National Institute of Child Health, the largest public-sector health facility for children’s treatment in Sindh.

‘Exercise under way to collect comprehensive data on the disease from various hospitals in Karachi’

Initially diagnosed in Hyderabad, the disease had also spread in Karachi, he added.

On treatment, he said the disease did not respond to most antibiotics, leaving physicians with only a few costly choices. “It adds extra burden on a patient. The treatment gets prolonged, compromising care of other patients, with high relapse rate, though the mortality rate is not high.”

Dr Raza, like other physicians, emphasised the need for creating public awareness of the disease. “Prevention is the key. People should consume only boiled water, homemade food prepared and cooked in properly cleaned utensils. Food handlers and consumers must follow good hygiene practices, including washing hands after defecation.”

‘A serious challenge’

Dr Naseem Salahuddin, a senior infectious diseases expert associated with the Indus Hospital, said drug resistant typhoid had become a serious challenge and an exercise was under way to collect comprehensive data on XDR typhoid from various public and private sector hospitals in the city.

“The disease is not being diagnosed early enough and patients often present complications. The misuse of antibiotics is very common in our society, a major reason behind the development of antibiotic resistance,” she said, adding that physicians should know that every fever was not viral and opt for a blood culture if a fever persisted.

According to her, vaccination provided 60 to 80 per cent protection against typhoid depending upon the type of vaccine used.

Dr Ejaz Vohra, a senior general physician practising at Ziauddin Hospital, Clifton, underscored the need for testing water in each locality and ensuring supply of safe drinking water.

“It’s sad that a preventable disease has taken a serious form. There is a dire need to create awareness of misuse of antibiotics and good hygiene practices,” he said, adding that it was hard to quantify the exact data on such patients as they were often treated in the outpatient departments, generally of public-sector hospitals.

Dr Qaiser Sajjad, representing the Pakistan Medical Association (PMA), called upon the government to include typhoid vaccine in the immunisation programme and provide it free at all public-sector hospitals.

“No one but the government is responsible for the health problems people face due to supply of contaminated water and it has to compensate people for that. It is unfortunate that there is no political vision or government focus on preventive care that can help reduce health spending,” he said.

US warning

He also referred to a recent health warning issued by the US Centres for Disease Control and Prevention that urged all travellers to “Pakistan or anywhere else in South Asia” to take extra care with food and water and get typhoid vaccination.

It also stated that the level-two alert had been triggered by the observation that several travellers to Pakistan returned to their home countries with drug resistant typhoid fever.

Highlighting the public health threat posed by waterborne diseases, he said: “These diseases claim life of 250,000 children under the age of five years every year in Pakistan. Around three million people in the country fall ill due to illnesses, such as hepatitis A, hepatitis E and gastroenteritis, all caused by contaminated water and food.”

It is election time and people should vote for those who offered solid commitments on public health and environment, he said.

The world’s first outbreak of XDR typhoid was reported in Hyderabad between 2016 and 2017, affecting 800 people. Only six cases of drug-resistant typhoid, however, were reported in Pakistan between 2009 and 2014.

Researchers from Britain’s Wellcome Sanger Institute, who analysed the genetics of the typhoid strain, found it had mutated and acquired an extra piece of DNA to become resistant to multiple antibiotics.

Typhoid is a highly contagious infection caused by the Salmonella enterica serovar Typhi bacteria. It is contracted by consuming contaminated foods or drinks and symptoms include nausea, fever, abdominal pain and pink spots on the chest. Untreated, it can be fatal.

Published in Dawn, July 12th, 2018